Active NPI
Kelly Jo Werner, CPNP
- Pediatric Nurse Practitioner
- Raleigh, NC
National Provider Identifier
1528024692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 005000606
- Practice address
- 2406 Blue Ridge Rd
Suite 100
Raleigh, NC 27607-6678 - Phone
- (919) 786-5001
- Fax
- (919) 786-5051
- NPI assigned
- Apr 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 005000606 | NC | Primary |
Addresses
Primary practice location
2406 Blue Ridge Rd
Suite 100
Raleigh, NC 27607-6678
Mailing address
2406 Blue Ridge Rd
Suite 100
Raleigh, NC 27607-6678
Phone (919) 786-5001
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005000606 | Other | NC | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Pediatric Nurse Practitioner, Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005000606 | NC | MD | Pediatric Nurse Practitioner |
Interoperability endpoints
- kellywerner@jmp.allscriptsdirect.net
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Adolescent Medicine Physician
- Raleigh, NC
- NPI 1962466631
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528024692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2406 BLUE RIDGE RD",
"address_2": "SUITE 100",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276076678",
"telephone_number": "919-786-5001",
"fax_number": "919-786-5051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2406 BLUE RIDGE RD",
"address_2": "SUITE 100",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276076678",
"telephone_number": "919-786-5001",
"fax_number": "919-786-5051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WERNER",
"first_name": "KELLY",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "NC",
"license": "005000606",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "005000606",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.